FCA Enforcement Trends in Healthcare: Record-Breaking Recoveries and Settlements, Lessons Learned, Mitigating Risks
Targeting Medicare Advantage and Managed Care, Prescription Drugs, Medically Unnecessary Care, Cybersecurity Misrepresentations
About the Course
Introduction
This CLE webinar will examine recent DOJ False Claims Act (FCA) enforcement activity against healthcare entities that resulted in record-breaking recoveries in FY 2025 totaling more than $5.7 billion. The panel will discuss notable and very costly enforcement actions and settlements, lessons to be learned, and current enforcement trends. The panel will also offer best practices for helping clients mitigate the risk of FCA enforcement action.
Description
Under an administration targeting healthcare fraud, it is not surprising that, of the record $6.8 billion in total FCA settlements and judgments recovered by the DOJ in FY 2025, healthcare-related actions accounted for the majority at over $5.7 billion in recoveries. Enforcement activity focused on Medicare Advantage fraud and managed care issues, prescription drug fraud, allegations of medically unnecessary care, and even cybersecurity misrepresentations.
Notable FCA enforcement actions and settlements included a more than $62 million settlement with Medicare Advantage provider Seoul Medical Group and associated entities for, among other things, submitting false diagnosis codes to increase MA payments; a $45 million settlement with Vohra Wound Physicians for overbilling for wound care services that were either not medically necessary or had not been performed; and a $9.8 million settlement against medical device manufacturer Illumina Inc. for failing to incorporate adequate cybersecurity in its software design and development.
Counsel and healthcare clients should understand DOJ enforcement focus, lessons to be learned from this historic FCA enforcement activity, and potential FCA enforcement trends.
Listen as our expert panel provides an update on FCA enforcement activity in the healthcare industry. The panel will examine key enforcement actions and settlements, review areas on which DOJ is currently focusing, and offer best practices for mitigating the risk of enforcement action.
Presented By
Ms. Barnes counsels clients in high-stakes matters related to fraud allegations, including in healthcare, federal contract procurement, and securities and financial services. A former trial attorney with the U.S. DOJ, she has extensive experience handling issues related to compliance, white-collar and regulatory investigations, and complex commercial litigation. Ms. Barnes represents businesses in public and non-public investigations, regulatory inquiries, and proceedings involving federal and state agencies. She frequently assists clients navigating government investigations related to allegations arising under the False Claims Act, Anti-Kickback Statute, Stark Law, and FIRREA. Ms. Barnes is also a recognized leader in her practice, frequently participating in various speaking engagements and authoring articles on critical topics such as cybersecurity, government contract billing, financial data rights, and developments related to the FCA.
Mr. Tarosky counsels providers of healthcare products and services, defense contractors, and financial institutions through confidential investigations under the False Claims Act, qui tam and government-initiated proceedings, and high-stakes litigation against whistleblowers and the U.S. He also represents clients in securities fraud and Foreign Corrupt Practices Act investigations and related litigation and defends media organizations facing defamation allegations. Mr. Tarosky was formerly with the DOJ Civil Division's Fraud Section, the clearinghouse for all False Claims Act activity in the country.
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This 90-minute webinar is eligible in most states for 1.5 CLE credits.
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Date + Time
- event
Thursday, June 25, 2026
- schedule
1:00 PM ET/10:00 AM PT
I. Introduction
A. Trump administration targets healthcare fraud
II. DOJ's record 2025 FY FCA recovery: healthcare focus
A. Medicare Advantage and managed care
B. Prescription drugs
C. Medically unnecessary care
D. Cybersecurity and digital health
III. Notable enforcement actions and settlements
A. Lessons to be learned
IV. Best practices for mitigating risk of enforcement action
V. Key takeaways
The panel will review these and other important considerations:
- Why was FY 2025 a record-breaking year in FCA recoveries against healthcare entities? In what areas did DOJ focus its enforcement activity?
- What lessons may be learned from notable settlements?
- What are current trends and developments in DOJ FCA enforcement?
- What are best practices for mitigating the risk of enforcement action?
